Coding Diabetes
The physician did not document the type of diabetes!
Chapter 3 ICD9 Guidelines
2. Type of diabetes mellitus not documented
If the type of diabetes mellitus is not
documented in the medical record the
default is type II.
250.00
th
5 digits in Diabetes
250.02
250.03
This code should only be
used if the physician
states that the diabetes is
“uncontrolled”.
This code should only be
used if the physician
states that the diabetes is
“uncontrolled”.
V58.67
This code is for Type II
Diabetics only.
Coding the Manifestations of
Diabetes
Chapter 3 Guidelines:
When assigning codes for diabetes and its associated conditions,
the codes from category 250 must be sequenced first.
Diabetic Neuropathy
250.60
357.2
Talk to your physician
about being specific
When coding hypertension it’s good to
know if it is malignant or benign.
401.9
Unspecified
401.0
Malignant hypertension: Severe high arterial blood pressure that
results in the necrosis of the kidneys and the retina.
401.1
Benign: Mildly elevated
arterial blood pressure.
Hypertensive Chronic Kidney
Disease
Assign a code from category 403 and
category 585 or 587
Hypertensive Heart and
Chronic Kidney Disease
Requires 3 codes
Guidelines State:
Assign codes from combination category 404, Hypertensive Heart and
chronic kidney disease, when both hypertensive kidney disease and
hypertensive heart disease are stated in the diagnosis. Assume a
relationship between the hypertension and the chronic kidney disease,
whether or not the condition is so designated. Assign an additional code
from category 428, to identify the type of heart failure. More than one
code may be assigned. The appropriate code from category 585 should be
used.
Elevated BP should not be
coded as HTN.
Elevated blood pressure:
Per the guidelines, “For a statement of elevated blood pressure
without further specificity, assign code 796.2, Elevated blood
pressure reading without diagnosis of hypertension, rather than a
code from category 401.
Unspecified
Hypertension, hypertensive (arterial) (arteriolar) (crisis)
(degeneration) (disease) (essential) (fluctuating)
(idiopathic) (intermittent) (labile) (low renin)
(orthostatic) (paroxysmal) (primary) (systemic)
(uncontrolled) (vascular)
with
chronic kidney disease
stage I through stage IV, or unspecified
stage V or end state renal disease
heart involvment (conditions classifiable to
429.0-429.3, 429.8, 429.9 due to hypertension)
(see also Hypertension, Heart)
Benign
Hypertension, hypertensive
Malignant
Hypertension Table
401.0
401.1
401.9
403.00
403.01
403.10
403.11
403.90
403.91
402.00
402.10
402.90
There are 5 Stages of CKD
Chronic Kidney Disease
585.1 Some kidney damage
585.2 Equates to mild CKD
585.3 Equates to moderate CKD
585.4 Equates to severe CKD
Stage 4
585.5
Chronic Kidney failure with a GFR value of less than 15.
585.6
End Stage Renal Disease
585.6 is assigned when the provider has
documented end-state-renal disease (ESRD)
If both a state of CKD and ESRD are
documented, assign code 585.6 only.
Review
Should V58.67 be used for patients with Type 1 Diabetes?
Poorly controlled diabetes is
uncontrolled diabetes
Dr. Connect has seen Sally for
5 years for HTN. For the last
5 years her diagnosis is 401.9.
Is this good or bad? What should be done about it?
When is it okay to code
585.6?
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